Distance to retail stores and risk of being homebound among older adults in a city severely affected by the 2011 Great East Japan Earthquake.

BACKGROUND: after the Great East Japan Earthquake in 2011, inactivity and the homebound status of older victims in affected areas have been a serious public health concern owing to the victims' prolonged existence as evacuees in mountainous areas. OBJECTIVE: to evaluate the association between distances to retail stores and risks of being homebound. DESIGN: secondary analysis of cross-sectional interview survey data with a geographical information analysis. SETTING: Rikuzentakata, Iwate, a municipality seriously damaged by the 2011 earthquake and tsunami. SUBJECTS: all Rikuzentakata residents aged 65 or older except for those living in temporary housing (n = 2,327). METHODS: we calculated road distances between each residential address and retail stores, hawker sites and shopping bus stops, accounting for the extra load caused by walking on slopes. The prevalence ratio of being homebound adjusted for age, source of income and morbidity by road distance was estimated using Poisson regression with a generalised estimating equation. RESULTS: those living at distances of 1,200 m or more were 1.78 (95% confidence intervals, 1.03-3.08) times more likely to be homebound (going out only every 4 or more days a week) among men and 1.85 (1.13-3.02) among women, compared with those residing in places <400 m from retail stores or shopping bus stops. The distances were reduced by new hawker and shopping bus services, but the improvements varied greatly across the districts. CONCLUSIONS: access to daily needs is essential to prevent homebound status. Post-disaster community diagnosis in terms of the built environment is important for strategic community restoration.

Social support improves mental health among the victims relocated to temporary housing following the Great East Japan Earthquake and Tsunami.

The victims of the Great East Japan Earthquake and Tsunami have been forced to live in temporary housing, mainly by two different methods of resettlement: group allocation that preserved pre-existing local social ties and lottery allocation. We examined the effects of various factors, including the resettlement methods and social support, on mental health. From February to March 2012, we completed a cross-sectional survey of 281 refugees aged 40 years or older, who had lost their homes in the tsunami and were living in temporary housing in Iwanuma city. Psychological distress of the victims was assessed using the Kessler Psychological Distress Scale (K6) that consists of six self-reported items. Participants were also asked whether they had provided or received social support during this time. Participants were categorized as "providing social support" if they listened to someone else's concerns and complaints, or "receiving social support" if they have someone who listened to their concerns and complaints. After adjusting for age and sex, multiple log-binomial regression analysis showed that participants without social support had a higher risk of psychological distress. Group allocation victims were more likely to receive social support than those who underwent lottery allocation. However, the resettlement approach did not significantly correlate with distress. Other factors associated with a higher risk of psychological distress were a younger age (55 or younger), living with either 3 people or 6 or more people, and having a lower income. The present results suggest that social support promotes the mental health of disaster victims.

Scaling up interventions to eliminate neonatal tetanus: factors associated with the coverage of tetanus toxoid and clean deliveries among women in Vientiane, Lao PDR.

The Lao People's Democratic Republic (PDR) is one of seven countries that have not eliminated maternal and neonatal tetanus in more than 50% of districts. We conducted a community-based household survey to assess the achievements of strategies towards maternal and neonatal tetanus elimination in the capital province. The coverage of tetanus toxoid (TT) was 79.7% by the protection-at-birth (PAB) method. The percentages of deliveries attended by skilled personnel and of deliveries at a health facility were 68.4% and 63.7%, respectively. The progress towards eliminating neonatal tetanus in Lao PDR is not sufficient despite the study sites being placed in the capital province. The lack of continuum of care for mothers and newborns is the major obstacle to scale up the tetanus toxoid coverage and PAB as well as clean deliveries.